Manager Compliance Audit

Job Description

Job Description

WHO WE’RE LOOKING FOR

Spectrum Vision Partners (“SVP”) and OCLI Vision (“OCLI”) work together to provide world class eye care to our patients to improve lives. SVP, the management services team, supports OCLI vision, one of the largest multi-specialty ophthalmology networks in the U.S. Our unique model and collaborative culture differentiate us in the marketplace and in our service to our patients. We build our culture one hire at a time. We want to build a great team that helps us focus on delivering exceptional eye care : the kind of team people want to be a part of, and the kind of team our patients can’t live without.

We want to learn more about you and the kind of team culture you can help us create. We’re interested in your relevant skills and what you can do. We’re even more interested in your positive attitude and flexible mindset!

THE OPPORTUNITY AT HAND

The Manager, Compliance Audit oversees, monitors, audits and conducts education activity for clinical services related to billing activity across the enterprise in accordance with the Compliance Program. You’ll ensure accurate and complete documentation, real-time monitoring, regulatory based education, and corrective action plans. You’ll ensure ongoing compliance with federal and state regulations and provide guidance and tools to assist departments in developing monitoring programs. You’ll serve as a front-line resource to our clinics and be their role model for ethical behavior and will promote an awareness and understanding of the corporate compliance program.

OUR EXPECTATIONS OF YOU

Identify trends in revenue cycle activities, including payments, denials, billing, coding and / or documentation errors and recommend action plans to address deficiencies

Conduct prospective and retrospective compliance documentation audits. Designs tools and methodologies for conducting audits. Tracks and trend result of audits. Track and analyze physician coding patterns and documentation. Prepares and presents reports on audit results, and maintains adequate documentation related to such and maintains integrity of the documentation whether in paper or electronic format

Prepare written reports summarizing billing compliance investigations / inquiries, for review, and approval

Develop, prepare and present reports related to billing trends, corrective actions, and compliance metrics

Perform routine and special compliance audit and monitoring as deemed necessary, including but not limited to, the management sanction / exclusion screening, OMIG, CMS, and OIG compliance, and payer compliance

Participate in the development and implementation of the annual compliance risk assessment and work plan as it relates to coding, billing, documentation initiatives

Manage Specialist, Billing Compliance Audit

Reviews the implementation of corrective action plans. Identifies trends in billing, coding and documentation errors and recommends corrective action plans. Monitors implementation and effectiveness of corrective action plans

Develops compliance policies and procedures related to billing, workflows and training materials, and orients and trains employees and providers on such

Stays abreast of industry developments pertaining to billing compliance, including OIG, OMIG, CMS

WHAT YOU’LL NEED TO SUCCEED

Bachelor's Degree or equivalent combination of education and related experience (10 years)

Must have 5+ years of experience in medical coding and 3+ years of auditing experience

Must have at least 2 years of experience in compliance department

Must have at least 2+ years of experience managing staff

Must be detail oriented and skilled at Microsoft Office Suite of products

Ability to prioritize and plan work independently with strong project management skills

Knowledge of Fraud Waste and Abuse Laws

Proficiency in auditing providers and auditors and conducting education feedback sessions.

Proficiency in identifying regulatory source for documentation guidance.

Must be analytical, trustworthy, and be a strong team player

Certified Professional Coder Certificate (CPC) required

Certifications in healthcare compliance and / or health care privacy, preferred

WHO WE ARE

Our globally recognized healthcare team is comprised of some of the top minds in ocular medicine. Our senior management team has a combined 200 years of eye industry experience collaborating with some of the most recognized practices in the nation. While our providers have the expertise to diagnose and treat complex ocular, oculoplastic, and retinal conditions, we’re also uniquely qualified to provide care for our patients from childhood though adulthood. We build relationships with our patients that last a lifetime

With nearly 1,400 employees, we support over 50 clinic locations, five state-licensed ambulatory surgery centers, and over 110 surgeons, doctors, and other medical professionals. Our brands include OCLI Vision, Island Eye Surgi-center, New Vision Cataract Center, AIO, and others.

At Spectrum Vision Partners we know that cultivating diversity and fostering an inclusive work environment is critical to our impact and success. We create an environment where no individual is advantaged or disadvantaged because of their background. We offer equal opportunity employment regardless of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability status, age, marital status, or protected veteran status. With a commitment to maintaining a bias-free environment in which harassment is prohibited, we respect cultural diversity and comply with the laws of the places in which we operate. We expect our business partners, suppliers, clients, and all of our team members to uphold these commitments.